Familial partial lipodystrophy (FPLD) is a rare, inherited disorder characterised by selective loss of adipose tissue, often affecting the limbs and gluteal region, and concurrent fat accumulation in the face, neck and intra-abdominal areas. This redistribution leads to profound insulin resistance, dyslipidaemia and fatty liver disease. It may be misdiagnosed clinically as type 1 diabetes (T1DM), particularly in patients with lean body habitus, or type 2 diabetes (T2DM) due to insulin resistance. We report a case of a young woman who was initially treated for presumed T1DM but was ultimately diagnosed with FPLD.
This article outlines my journey through the diagnosis and management of postprandial hyperglycaemia, highlighting the challenges, interventions, and insights gleaned along the way
Background: Diabetic ketoacidosis (DKA) remains a common cause of emergency admission in people with type 1 diabetes (T1DM) and is associated with significant morbidity and mortality. Recurrent DKA admissions may reflect unmet needs beyond acute metabolic management, including gaps in structured education, discharge safety-netting and psychosocial support. Understanding local patterns of recurrent DKA is essential to inform preventative strategies. Methods: We conducted a retrospective service evaluation at a large teaching hospital between 1st July and 31st December 2024. This study was designed as a baseline evaluation informing the first stage of a multi-cycle quality improvement (QI) project, conducted in accordance with SQUIRE 2.0 guidelines. Routinely collected, clinically coded discharge data were used to identify adults with T1DM admitted with DKA. Recurrent DKA was defined as two or more admissions within a rolling 12-month period, assessing admissions during the study window. Lifetime admissions within the cohort were also studied. Electronic health records were reviewed to identify demographic characteristics, documented triggers, psychosocial factors and sick-day rule education documentation. A survey of resident doctors was conducted to assess training exposure and confidence in delivering DKA prevention education. Results: The 210 DKA admissions during the evaluation period corresponded to 57 unique adult patients with T1DM, of whom 41 (72%) were identified as having recurrent DKA (59% female [n=24]; 73% White British [n=30], 17% Asian [n=7], 5% Black or African [n=2], 5% Mixed ethnicity [n=2]). Admissions were concentrated within a small number of individuals: 17 patients (41%) had 2-4 lifetime DKA admissions, 16 patients (39%) had 5-9 admissions, and 8 patients (20%) had 10 or more admissions. Documented sick-day rule education was present in 61% of patients (n=25), absent in 34% (n=14), and 5% (n=2) self-discharged prior to diabetes team review. Psychosocial triggers were identified in a subset of patients, with mental health conditions and substance misuse most frequently documented among those with the highest admission frequencies. Of 20 resident doctors surveyed, only 35% (n=7) reported receiving formal teaching on sick-day rules, and 85% (n=17) reported low confidence in delivering personalised written discharge advice. Conclusion: Recurrent DKA admissions are concentrated within a small, high-risk cohort and are associated with deficiencies in inpatient education, discharge safety-netting and psychosocial support. These findings support recurrent DKA as a marker of psychological and social vulnerability. This baseline evaluation identifies clear targets for a multi-faceted preventative quality improvement approach, including standardised discharge documentation, clinician education and integrated psychosocial support.
A reflective piece highlighting the most important learning points following diagnosis with type 1 diabetes (T1DM). You do not need to be severely unwell to have diabetic ketoacidosis (DKA); a T1DM diagnosis should be treated as breaking bad news; and the psychological aspects of T1DM should not be overlooked.
Background: Diabetic foot ulcers (DFUs) are associated with high morbidity and mortality. This study examined factors associated with earlier death in patients managed within a multidisciplinary foot clinic. Methods: We performed a retrospective study of 138 patients with DFUs who died in the year 2024. Cause of death assessed through Medical Certificate of Cause of Death (MCCD). Complementary multivariable linear and logistic regression analyses were used to identify factors associated with younger age at death and premature mortality (age < 70 years). Results: Cardiovascular disease was the leading cause of death (28.3%). Smoking, poor glycaemic control, renal replacement therapy, and prior lower-limb amputation were independently associated with premature mortality, while prior revascularisation was associated with lower odds of early death. Conclusion: Patients with DFUs who are actively smoking with adverse severity markers are at high risk of premature death. Multidisciplinary foot clinic should also include cardiovascular risk optimisation.
The topic for the 2016 award is the 'best joint pharmacy and diabetes team initiative to improve insulin and prescribing safety in hospital'.The judging criteria are defined by the Safe Insulin Prescribing Group (Umesh Dashora, Debbie Stanisstreet and Erwin Castro) on behalf of the Joint British Diabetes Societies.The submissions will be scored
Chronic kidney disease (CKD) and diabetes mellitus (DM) often coexist and pose distinctive dietary difficulties for patients. While CKD recommendations underscore nutrient limitations, specifically for potassium and phosphate, diabetes dietary guidelines highlight balanced carbohydrate consumption, and increased intake of fruit and vegetables. These interrelating yet conflicting needs cause stress and confusion among patients, often resulting in poor dietary compliance. Advances in renal nutrition recommendations promote a more flexible and personalized approach, identifying the lower bioavailability of potassium in whole foods and the substantial contribution of food additives to nutrient surplus. These advances enable higher compliance with diabetes dietary principles and support plant- based approaches that enhance both glycaemic and renal outcomes. Nonetheless, dietary management remains disintegrated, with renal and diabetes dietitians usually working independently, since there is no integrated training pathway for dietitians to obtain dual expertise. A multidisciplinary approach is crucial, and training individual dietitians with unified proficiencies could rationalize care, reduce patient confusion and improve patient outcomes. This review delves into the clinical evolution of renal-diabetes dietary guidance, patient experiences, and the urgent need for cohesive and collective dietetic care.
Diabetic kidney disease (DKD) management is a rapidly evolving field. Alongside risk prediction tools, such as the Kidney Failure Risk Equation, there is greater emphasis on person-centred care and education. For people with type 2 diabetes (T2DM), sodium-glucose cotransporter 2 inhibitors (SGLTi) and finerenone have joined the five previous pillars of care which are foundations for both type 1 diabetes (T1DM) and T2DM. These include blood glucose optimisation, blood pressure management, renin–angiotensin–aldosterone system inhibitors (RAASi), lipid management and smoking cessation. The evolution of hyperkalaemia management, due to the availability of potassium binders, has enabled the optimal use of RAASi. Ongoing studies in people with T1DM will further inform DKD management in the future.
Post-transplantation diabetes mellitus (PTDM) is a common complication seen after kidney transplantation and is associated with adverse outcomes. There is a lack of robust evidence-based medicine to guide clinical decision making in the prevention or management of PTDM. Despite the availability of professional society guidelines and expert consensus reports, this paucity of data translates into clinical challenges in day- to-day practice for transplant and diabetes professionals. In this article, four common clinical scenarios associated with PTDM are discussed which offer advice for bridging the gap between evidence- based guidelines and real-world practice.
We present a case of type 1 diabetes (T1DM) in a middle-aged Caucasian woman who initially presented with phenotypic characteristics of type 2 diabetes (T2DM) and whose type 2 phenotype contributed to accelerated progression of T1DM. This case illustrates the challenges in making a clinical diagnosis of T1DM in patients who also have phenotypic features of T2DM. Recognising such presentations is important in order to make the correct diagnosis and potentially to offer immunotherapy-based interventions while beta cell function is still relatively well preserved.
